- Evolent (Lansing, MI)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... for the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management, you will be...within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure… more
- Evolent (Lansing, MI)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Lansing, MI)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... and provides clinical rationale for standard and expedited appeals. . Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Lansing, MI)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... + Provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Lansing, MI)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Highmark Health (Lansing, MI)
- …DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the multidisciplinary team ... :** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities...care of our members **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy… more
- Corewell Health (Royal Oak, MI)
- …patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. ... years of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred + Registered… more
- Corewell Health (Dearborn, MI)
- …patients. + Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). + ... years of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred + Registered… more
- Tenet Healthcare (Detroit, MI)
- …of care based on Medical Necessity process and submits case for Secondary Physician review per Tenet policy. Ensures timely communication of clinical data to ... activities: a) accurate medical necessity screening and submission for Physician Advisor review , b) care coordination, c) transition planning assessment… more
- Humana (Lansing, MI)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... and will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to… more